Healthcare Provider Details

I. General information

NPI: 1144522749
Provider Name (Legal Business Name): LE ANN D DURFEY CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 S MAIN ST STE 100
LOGAN UT
84321
US

IV. Provider business mailing address

878 N 6400 W
MENDON UT
84325-9728
US

V. Phone/Fax

Practice location:
  • Phone: 435-764-2510
  • Fax: 855-292-2325
Mailing address:
  • Phone: 435-764-2510
  • Fax: 855-292-2325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4910130-3501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: